Provider Demographics
NPI:1073516274
Name:CHINTANADILOK, JIRAYOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JIRAYOS
Middle Name:
Last Name:CHINTANADILOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1917
Mailing Address - Country:US
Mailing Address - Phone:850-482-2061
Mailing Address - Fax:850-482-6617
Practice Address - Street 1:4296 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2173
Practice Address - Country:US
Practice Address - Phone:850-482-2061
Practice Address - Fax:850-482-6617
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77246207R00000X, 207RP1001X, 207RS0012X
IN01087460A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257575200Medicaid
49372AMedicare ID - Type Unspecified
H05715Medicare UPIN